Citizens announced on December 13, 2023, changes to our eligibility rules to comply with SB 7052. The information outlined here will guide agents when submitting a risk with existing damage after an insurance company becomes insolvent.

Note: Failure to complete the eligibility requirements described below may result in a performance violation and may cause the policy to be cancelled.

Eligibility Rule

Citizens cannot deny an application for coverage solely because of unrepaired damage caused by a covered loss that is the subject of a Florida Insurance Guaranty Association (FIGA) claim. This applies to a risk until the earlier of 24 months after the date the FIGA began servicing such claim or FIGA closes the claim, whichever is earlier.

Submitting a New-Business Application

The following eligibility question and damage description field has been added to the application to indicate the risk has existing damage that is the subject of a FIGA claim:

Figure 1: Eligibility questions for existing damage serviced by a FIGA claim

For a risk with existing damage, an agent should answer Yes to this eligibility question only when the risk (at the time of the application) has an open claim now being serviced by FIGA due to the insolvency of a prior insurer. Agents must enter a description of the existing damage (e.g., roof leak, water damage).

The agent must complete the Prior Losses section with the open claim details. The Status Open with FIGA should be selected, and the cancellation effective date of the insolvent carrier policy must be entered in the FIGA Open Service Date field:  

 Figure 2: Status and FIGA Open Service Date on the Prior Losses tab

Required Documents

The following Required Documents will trigger when the eligibility question is answered Yes on the application, indicating the applicant has an open FIGA claim and that FIGA began servicing such claim within 24 months prior to the effective date of the policy applied for with Citizens:

• Policyholder Affirmation Regarding FIGA Claims – applicants are required to sign the form. This form confirms that the applicant understands that Citizens’ policies do not cover damage that occurred before policy inception and requires a detailed description of the unrepaired damage and photos.
• Existing Damage FIGA Claim – submit a detailed description and photos of the existing damage or loss that is serviced by or filed with FIGA.

When the claim status is Closed, or Open outside the 24-month period, an Intent to Repair document is required. The applicant must submit a description and photos of the existing damage and documentation showing when repairs will be completed.

Notes:

• If available, submit the letter sent to the applicant from FIGA informing them their open claim is now being serviced by FIGA.
• The Policyholder Affirmation Regarding FIGA Claims form can be signed electronically.

Resources

Log in to the Agents website to access the Underwriting Guidelines and submission forms:

• Select Personal, and then select the appropriate policy type and scroll down to the most recent edition of the Underwriting Guidelines.
• Select Personal > PR-M or PR-W, and look under General for the Policyholder Affirmation Regarding FIGA Claims.